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In practice, a systematic approach is needed that allows you to combine the assessment and further changes in marketing activities. Such an approach should take into account the adoption of managerial decisions regarding improving the efficiency of marketing based on a system of assessment indicators, both marketing activities and the business as a whole, and provide for a program of coordinated changes in business and marketing, which allows to improve these indicators. taking into account the characteristics of the external environment and the resource potential of the enterprise. The result of using this approach is a more efficient state of marketing and business systems, ensuring their interconnection and coordination, taking into account market conditions. The development and implementation of a systematic approach contributes to the application of the theory and methodology of change management in the context of increasing the effectiveness of marketing activities.

Juvenile myoclonic epilepsy (JME) is a well-defined sub-syndrome of idiopathic generalized/genetic epilepsy, usually presenting in adolescence and characterized by myoclonic jerks, predominately in the arms, associated with tonic-clonic seizures and less often generalized absences. Although the evidence base for a relationship between JME and sleep disorders is weak, most experts regard sleep disorders as an actual comorbidity. This paper reviews the literature underpinning the development of sleep disorders in JME patients. Data that report associated causes of sleep problems in JME patients are discussed, as is the importance of counseling on lifestyle issues. Lastly, a practical approach to managing sleep disorders in young men and women with JME is summarized.

Background:The shoulder is the most complex joint in the body. The large freedom of motion in this joint is the main cause of instability. Instability varies in its degree, direction, etiology and volition and there is a large spectrum of conditions.Methods:Based on literature research and also in our own experience, we propose to elucidate the reader about the natural history of instability and its importance for the appropriate management of this pathology, by answering the following questions:What happens in the shoulder after the first dislocation? Which structures suffer damage? Who are the patients at higher risk of recurrence? How does the disease evolve without treatment? Will surgical treatment avoid future negative outcomes and prevent degenerative joint disease? Who should we treat and when?Results:80% of anterior-inferior dislocations occur in young patients. Recurrent instability is common and multiple dislocations are the rule. Instability is influenced by a large number of variables, including age of onset, activity profile, number of episodes,delay between first episode and surgical treatment.Conclusion:Understanding the disease and its natural evolution is determinant to decide the treatment in order to obtain the best outcome. It is crucial to identify the risk factors for recurrence. Delay in surgical treatment, when indicated, leads to worse results. Surgical technique should address the type and severity of both soft tissue and bone lesions, when present.

La calidad en el servicio se ha adquirido de mucha importancia en los últimos años en todos los negocios, debido a que los clientes actualmente tienen expectativas muy elevadas y las competencias son mayores, ya que cada empresa trata de igualarse o exceder dichas expectativas. Se deben ofrecer buenos servicios de calidad y anticiparse para responder a una amplia de necesidades de los clientes. La calidad en el servicio no solamente se trata de cómo saber manejar un producto, si no como servir a los clientes antes y después de su manejo. Es por eso que la calidad en el servicio es utilizada en las organizaciones como dicha herramienta de diferenciación., {"references":["Álvarez, M. (2006). Introducción a la Calidad: aproximación a los sistemas de gestión y herramientas de Calidad. España: Ed. Ideas Propias","Blanco, P. (2001). Atención al Cliente. México: Pirámide","Bonta P. & Faber M. . (2003). Preguntas sobreMarketing y Publicidad. México: Norma","Hernández, Fernández & Baptista. (2010). Metodología de la Investigación. México: Mc Graw Hill","Kotler & Armstrong, G. (2004). Principles of Marketing. New Jersey: Pearson 10th edition","Kotler Bloom & Hayes, P. P. (2004). El Marketing de Servicios Profesionales. España: Paidós","Kotler, P. (2012). Marketing. México: Pearson","Lamb Hair & McDaniel, C. (2005). Fundamentos de Marketing. Madrid. España: Paraninfo","Méndez A., C. (1995). Metodología: Guíapara elaborar diseños de investigación en ciencias económicas, contables y administrativas. México: McGraw Hill","Morales & Hernández. (12 de abril de 2004). La Calidad y su Gestión. Obtenido 24Revista GEON Vol 5 No 2 julio diciembre 2018ISSN 2346-3910 En línea Revista GEON Vol 6No 2julio diciembre 2019La atención al cliente, el servicio,el producto y el precio como variables determinantes de la satisfacción del cliente en una pyme de servicios,Nemecio Valenzuela Salazar, Clara Buentello Martínez, Lilia Gómez, VerónicaVillarreal Sánchez, 18-24de http://www.efdeportes.com/efd76/calidad.htm","Sandhusen, L. (2002). Mercadotecnia Internacional. México: Thompson.","SangriCoral, A. (2008). Introducción a la Mercadotecnia. México: Patria","Solorzano Barrera, G. J. (30 de Septiembre de 2013). Importancia de la calidad del servicio al cliente para el funcionamiento de las empresas. El Buzón de Pacioli(82), 25. Recuperado el 16de noviembre de 2018, de http://www.itson.mx/publicaciones/pacioli/Documents/no82/Pacioli-82pdf","Welch S, & Comer J. (1988). Quantitative Methods for Public Administration: Techniques and Applications. U.S.A: Books/ Cole Publishing Co"]}

Objective: The purpose of the study was to analyze clinical presentation, surgical management, and long-term outcome of patients suffering from biliary diverticulum, namely Todani type II congenital bile duct cyst (BDC). Background: The disease incidence ranges between 0.8% and 5% of all reported BDC cases with a lack of information about clinical presentation, management, and outcome. Methods: A multicenter European retrospective study was conducted by the French Surgical Association. The patients' medical records were included in a Web site database. Diagnostic imaging studies, operative and pathology reports underwent central revision. Results: Among 350 patients with congenital BDC, 19 type II were identified (5.4%), 17 in adults (89.5%) and 2 in children. The biliary diverticulum was located at the upper, middle, and lower part of the extrahepatic biliary tree in 11, 4, and 4 patients (58%, 21%, and 21%, respectively). Complicated presentation occurred in 6 patients (31.6%), including one case of synchronous carcinoma. Surgical techniques included diverticulum excision in all patients. Associated resection of the extrahepatic biliary tree was required in 11 cases (58%) and could be predicted by the presence of complicated clinical presentation. There was no mortality. Long-term outcome was excellent in 89.5% of patients (median follow-uptime: 52 months). Conclusions: According to the present largest Western series of Todani type II BDC, the type of clinical presentation rather than BDC location, was able to guide the extent of biliary resection. Excellent long-term outcome can be achieved in expert centers.

In today`s globalized business environments the road to survival and success is through customer satisfaction. Particularly for the service companies, employees are also required to show emotional labor in the service delivery in addition to their physical performance based on the fact that customer satisfaction is directly related to the emotions displayed by employees. Canalizing employees to perform emotional labor is an important issue. Here, the internal marketing practices emerge as a managerial tool. Accordingly employees perceptions towards internal marketing practices that are considered to have important consequences on companies, and the way internal marketing practices affect employees ‘emotional labor behavior are the matters of concern. The purpose of this study is to examine how internal marketing activities in tourism enterprises affect the behavior of emotional labor of the staff working in tourism enterprises. In this study, the effects of internal marketing activities on to the behavior of emotional labor of employees were examined. The survey was conducted on 136 employees working in hotel businesses operating in the Kocaeli province tourism sector and the hypotheses developed to investigate whether the internal marketing policies applied by hotel operators affect the behavior of emotional labor and the hypotheses developed for this purpose were tested with structural equation model as the SmartPLS 2.0. The literature of the study as conceptually has been extensively reviewed and after the analysis the findings of the research have been interpreted according to the literature. Findings show that internal marketing practices are positively and significantly related to surface acting and deep acting. Moreover, findings do not provide any empirical evidence to support the direct relationship between internal marketing practices and emotional mismatch. In addition to that, in the study some issues such as the importance of emotional labor for tourism enterprises and the relationship between the practices of internal marketing and emotional labor are discussed and suggested

The aim of this paper is analys of the state of electronic services within the postal system in Serbia in order to improve the management of this services. As an indicator of the state of development we can use benchmarking index of development of postal e-services. Benchmarking index is created by PCA (Principal Component Analysis) method in statistical software Minitab which has been designed for PCA. The development of electronic economy has influence on postal system to improve postal electronic services. In conclusion we can say those who make the decisions and management experts have to define appropriate strategy of e-services.

The present study was conducted in order to examine job stress and organizational commitment of employees in tourism establishments (hotel, restaurant, travel agency, etc.) in Cesme and Kartepe destinations which have different touristic attractions. The study survey was administered to a total of 351 employees working at tourism establishments in Cesme, a summer tourism destination in the province of Izmir and Kartepe, a winter tourism destination in the province of Kocaeli. The data obtained as a result of the study were analyzed with computer software for the purpose of the study. Frequency and percentage distributions were examined in order to reveal demographic characteristics and t-test and pearson correlation analysis were used to test hypotheses. No significant difference in terms of job stress was found between employees working at tourism establishments in Cesme and Kartepe depending on their destination. A significant difference was observed in the organizational commitment scale between employees depending on their destination. According to this result, comparing answers given to the organizational commitment scale according to the distinction of Cesme and Kartepe, it was found that employees working in Cesme had higher organizational commitment. A weak, negative and significant correlation was observed between job stress and organizational commitment of employees working at tourism establishment. OzetBu calisma, farkli turistik cekiciliklere sahip olan Cesme ve Kartepe destinasyonlarinda calisan turizm isletmeleri personelinin, is stresleri ve orgutsel bagliliklari iliskisinin incelenmesi amaciyla yapilmistir. Arastirma anketi, Izmir ili Cesme yaz turizmi destinasyonu ve Kocaeli-Kartepe kis turizmi destinasyonunda yer alan turizm isletmelerinde calisan toplam 351 personele uygulanmistir. Arastirma sonucunda elde edilen veriler arastirma amaci kapsaminda bilgisayar programi ile analiz edilmistir. Calismada demografik ozellikleri ortaya cikarmak amaci ile frekans ve yuzde dagilimlari incelenmis, hipotezleri test etmek amaciyla t-testi ve pearson korelasyon analizi kullanilmistir. Cesme ve Kartepe’de calisan turizm isletmeleri personeli, calistiklari destinasyonlara gore degerlendirildiginde, is stresi olceginde anlamli farklilasmanin olmadigi, gorulmustur. Personel calistiklari yere gore degerlendirildiginde ise, orgutsel baglilik olceginde anlamli bir farklilasmanin oldugu gorulmustur. Orgutsel baglilik olcegine verilen cevaplari Cesme (yaz turizmi), Kartepe (kis turizmi) ayrimina gore karsilastirdigimizda, Cesme destinasyonunda calisan personelin orgutsel bagliliginin daha yuksek oldugu anlasilmaktadir. Turizm isletmeleri personelinin is stresi ile orgutsel bagliligi arasinda ise, dusuk duzeyde negatif ve anlamli bir iliski oldugu gorulmustur.

Before 2000, allogeneic hematopoietic stem cell transplantation (HSCT) was the only potentially curative treatment for children with chronic myeloid leukemia (CML) in chronic phase (CP). The availability of imatinib (IM) and thereafter of second-generation (2G) tyrosine kinase inhibitors (TKIs) has extended therapeutic options for childhood CML. Experience with IM in managing children and adolescents with CP-CML resistant or intolerant to interferon treatment treated prompted us to outline guidelines with the aim of offering a uniform management approach for this category of patients (pts). IM was scheduled in newly diagnosed pts with CML in CP, including those with an HLA identical sibling (HLA+). Cytogenetics on bone marrow (BM) and molecular analysis on peripheral blood (PB) and on BM were suggested at planned time-points. These guidelines have been shared with both pediatric referral centers (P Centers) and reference center for adults and children (AP Centers) in Italy. The guidelines, summarized in Figure 1, have been updated over the years (yrs), with the contribution of colleagues managing adult CML. Fifty-seven CP-CML pts with a median age of 11.4 yrs, diagnosed between March 2001 and June 2015, were managed at 9 P centers (34 pts) and at 4 AP Centers (23 pts). All pts, including 16 with an HLA+, started IM that was discontinued early in 2 pts due to toxicity. HSCT from an HLA+ donor was performed in 2 pts in CP. A bone marrow aspirate at 3, 6, 9, 12, 18, 24 months was carried out in 85.5%, 98%, 83.5%, 100%, 95% and 94% of pts, respectively. Rates of molecular assessments on BM at 3, 6, 9, 12, 18 and 24 months were 73%, 78%, 92%, 84%, 86% and 100% of pts, respectively, significantly higher at 6 and 9 months in pts followed at P centers compared to those followed at AP centers. Cytogenetic evaluation rates at the same time points were 69%, 80%, 81%, 82% 73% and 75%, respectively, significantly higher in pts followed at AP centers compared to those followed at P centers. Rates of molecular assessments on PB at 3, 6, 9, 12, 18 and 24 months were 50%, 54%, 57%, 60%, 64% and 69% of pts, respectively, higher in pts followed at AP centers compared to those followed at P centers. Four pts (1 with HLA+) resistant to IM were rescued with 2G TKI and 3 of them then underwent a HSCT. Fifty pts (92.5%), including 13 HLA+ pts, achieved a cytogenetic or molecular (MR). Seven of the 50 responders (14%) underwent a HSCT from an HLA+ (6 pts) or from a matched unrelated donor (MUD), all in P centers before 2009. Seven HLA+ pts continued IM: in 3 it was given intermittently and thereafter discontinued in 1. Among the 36 responders without a HLA-identical sibling (HLA-), 10 pts (persistent MR, 2 pts; late side effects, 5 pts; poor compliance, 3pts) started intermittent IM, that was discontinued in 3 of them with deep MR. Overall, 18/36 (50%) pts failed IM: 2 had late toxicity and 16 (44%) developed disease recurrence (5 on intermittent IM and 1 pt after IM discontinuation). BCR-ABL1 mutation analysis was carried out in 11 pts: BCR-ABL1E255K combined with BCR-ABL1F359Vmutations were found in 1 pt and BCR-ABL135INS in 5 pts. Eleven pts were rescued with 2G TKIs (Dasatinib, 5 pts; Nilotinib, 6 pts), 5 pts restarted continuous IM and 2pts underwent a HSCT from a MUD. All 57 pts are alive at a median follow-up of 72 months (range, 12-184): 15 pts (26%) after a HSCT (HLA+, 9 pts; MUD, 6), 4 pts (7%) are treatment-free (1 pt after nilotinib), 27 pts (47.5%) are still receiving IM (continuous, 22 pts; intermittent, 5 pts), 10 pts (17.5%) are on treatment with 2G TKIs (dasatinib, 5 pts; nilotinib, 5 pts) and 1 pt with BCR-ABL1E255K and BCR-ABL1F359Vmutations is on third-line treatment with ponatinib. Our experience shows that pediatric guidelines are an important management tool for children and adolescents with CP-CML. Over the years, exchange of experience for monitoring and treatment of pediatric CP-CML with colleagues managing adult pts has contributed to update management strategies for this particular category of pts. Furthermore, exchange of knowledge and debate concerning some clinical situations within our network has allowed to have a progressively uniform approach for children and adolescents followed in these 13 Italian centers. Taking into account the rarity of the condition, shared pediatric guidelines and exchanges of experience and knowledge with adult hematologists will further contribute to an optimal management of childhood CML. Disclosures Biondi: BMS: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees, Other: Advisory Board; Cellgene: Other: Advisory Board. Saglio:Ariad: Consultancy; Pfizer: Consultancy; Bristol Myers Squibb: Consultancy. Foà:BMS: Consultancy; Ariad: Speakers Bureau; Roche: Consultancy, Speakers Bureau; Pfizer: Speakers Bureau; Celgene: Consultancy, Speakers Bureau; Genentech: Consultancy; Gilead: Consultancy, Speakers Bureau; Janssen: Consultancy, Speakers Bureau; Amgen: Consultancy, Speakers Bureau.

Numerous studies in the world of market economy show that the share of small and medium size enterprises is constantly increasing compared to large enterprises. This does not decrease the significance of large enterprises, but the dependence between them gets larger every day. National economies which manage to find the optimal combination between small, medium size and large enterprises are more successful than the others. Management of small and medium size enterprises (SMEs) in conceptual terms is similar to the process of management of large enterprises. An organization must be managed in order to function and this rule applies to small and medium size enterprises.

Culture is a way for organizations to learn environmental factors. There are many definitions for culture. “Issue of” difference” with the leader of the director, including material that is much discussed in current and most experts believe that leadership is something different from the management

Some authors have assessed the feasibility of laparoscopy in the treatment of postoperative adhesive obstruction, but conclusions about its effectiveness are related to different selection criteria used for surgery. This paper reports on our experience in laparoscopic adhesiolysis and analyses the results on the basis of the selection criteria used. From January 1993 to December 2001, 65 patients were submitted to laparoscopic adhesiolysis for small bowel obstruction according to specific selection criteria. Of the 65 patients, 40 were admitted for acute obstruction and 25 for chronic or recurrent transit disturbances. Correlation between historical and clinical data and the results of surgical treatment were statistically analyzed. The procedure was completed by laparoscopy in 52 patients (conversion rate: 20%). Mean postoperative stay was 4.4 days with a 12.3% morbidity and no mortality. Recurrence rate was 15.4%; a single correlation was found between recurrence and age. Laparoscopic adhesiolysis in the treatment of small bowel obstructions seems to be effective; further studies are required to define selection criteria for surgery and confirm real advantages in terms of recurrences.

This paper presents a comprehensive casting classification and coding system for the casting production industry. The general structure of the system is suitable for every joint within CIMS (Computer Integrated Manufacturing System). It is a hierarchical and flexible structured system. The first hierarchy, describing general information about the casting, is called the comprehensive code for first stage code and it consists of 15 codes, of which the first 9 digits are fixed codes and the latter 6 digits/characters, which concern process characteristics of castings, are flexible codes. the second hierarchy, called the second stage code, is used to describe the shape characteristics of the casting and its gating system in detail. the main structure and the realisation method used in this casting classification and coding system are also introduced.

The present study shows the results of a research aimed at the knowledge of the significant features of Catania's urban environment. The complexity of the different features of the city, the several scales of representation, the multi-dimensional objects and the historical, anthropic, formal relations have produced different kinds of information requiring a flexible instrument that is able to transcribe images, charts, texts and symbols in a single model of representation. In the perspective of creating a fundamental cognitive framework, the research team paid attention at drawing up a GIS (Geographic Information System) for documenting and managing historic urban heritage. The idea is to have a structure able to collect data like a logic archival system or an open database, which can immediately be consulted and constantly implemented. Indeed, the aim of this GIS is to organize, manage, query and visualise the peculiar aspects which characterize Catania's architectures. Thanks to multi-directional "access-windows" it is possible to navigate through its contents (texts, drawings, 3D rendering, pictures, historical documents). The system will also allow the integration of several documents in a common geo-database up to visualise the most meaningful details. Its use could assure suitable proposals of urban transformations and coherent plans in using and/or managing heritage goods for a sustainable city development.

Objective: Salivary gland ultrasound (SGUS) is emerging as a valid tool in the management of primary Sjögren's syndrome (pSS). This study aimed to investigate whether pSS patients with normal-appearing or pathological SGUS findings showed different clinical, laboratory, and pathologic pSS-related features, and to compare the results by using two different SGUS scores.Methods: Consecutive pSS patients, according to the ACR-EULAR classification criteria, were evaluated. Salivary glands were scored using the early 1992 score by De Vita et al. and the latest 2019 OMERACT score, both being semiquantitative 0–3 scoring systems focused on ultrasonographic parenchymal inhomogeneity (grades 0 and 1, normal-appearing; grades 2 and 3, pathological). The patients were then divided into two groups: “SGUS normal-appearing” if all the salivary glands had normal-appearing parenchyma (grade 0 or 1), or “SGUS pathological” if the grade was 2 or 3 in at least one salivary gland. The associations between SGUS and pSS-related clinical, laboratory, and pathological features were then investigated in the two groups.Results: One hundred pSS patients were evaluated, the mean age (±SD) was 60.9 ± 12.0 years, and mean disease duration was 11.7 ± 7.2 years. Twenty-nine out of 100 (29%) patients were in the “SGUS normal-appearing” group and 71/100 (71%) were in the “SGUS pathological” group. A normal-appearing SGUS was significantly associated with the absence of anti-La/SSB antibodies (p < 0.001) and normal unstimulated salivary flow rate (p = 0.02) by both univariate and multivariate analyses. By univariate analysis, a normal-appearing SGUS was significantly associated also with the absence of rheumatoid factor (p = 0.002) and of serum monoclonal component (p = 0.003), ESSDAI < 5 (p = 0.03), and with a negative lip biopsy (p = 0.029). No associations were found with other items, including anti-Ro/SSA (p = 0.145), Schirmer's test (p = 0.793), ESSPRI (p = 0.47), and demographic data. No differences in these results were observed by using the two SGUS scoring systems.Conclusion: The SGUS allowed the identification of different phenotypes of pSS, and different SGUS scores focused on salivary gland inhomogeneity may be effective to this end.

In recent years, Australian universities have been driven by a diversity of external forces, including funding cuts, massification of higher education, and changing student demographics, to reform their relationship with students and improve teaching and learning, particularly for those studying off-campus or part-time. Many universities have responded to these forces either through formal strategic plans developed top-down by executive staff or through organic developments arising from staff in a bottom-up approach. By contrast, much of Murdoch University's response has been led by a small number of staff who have middle management responsibilities and who have championed the reform of key university functions, largely in spite of current policy or accepted practice. This paper argues that the "middle-out" strategy has both a basis in change management theory and practice, and a number of strengths, including low risk, low cost, and high sustainability. Three linked examples of middle-out change management in teaching and learning at Murdoch University are described and the outcomes analyzed to demonstrate the benefits and pitfalls of this approach.